Hi all,
I am a type-1 diabetic living in India. I have been living with for close to 6 years now. I inject insulin - Actrapid Novolet and Insulatard Novolet twice a day, once in the morning and once at night. I have my own glucometer with which I occasionally check my blood sugar (maybe on the order of once a week). I take multi-vitamin supplement tablets that my doctor has prescribed.
Food, I try to split it over the day to atleast 5-6 times, but haven’t been able to do it on a consistent basis.
I would like to know what all stuff you guys do, things that you use for diabetic care. This is just to know about things that I don’t already know and see if I can use them in my life to try living a healthier life.
Hi Sally,
My last A1C was 9.9. I realize that I am still far from the ideal zone and am thinking of what I can do to improve the situation. I can always feel the physical effects when the blood sugar level is high or about to go low, but the in-between range is always tricky and I have to agree with you that testing is the only way to keep track of blood sugar level which in turn will help in achieving better control.
I am very particular about avoiding hypos nowadays because I am a Software Engineer and my work requires sitting in front of the computer and using it. Whenever I get a hypo, I immediately get a severe headache that will go away only after I take something and sleep for some time. I also understand how dangerous hypoglycemia can be and hence am very cautious about it.
The other extreme is more tricky, I test my blood sugar level and if it is high I adjust my insulin, food and physical activities accordingly, but more often it will oscillate to the other extreme. I understand that this is a part and parcel of life with diabetes and the sooner I handle it properly the better for me.
Till some time back, the diabetes related expenses were too expensive, but I have started working now and I feel that I can handle the financial part of it way better now. I realize that I need to do a lot of things unless I want to end up with a poor health which is a huge risk for diabetics.
I wish things like CGM, pumps and etc. would be widely available here so that I can try achieving better control like most of my peers in other countries do. But I also realize that with what is available and possible here, it is definitely possible to achieve far better control than I have managed. So I wanted to get some inputs that could help me in the endeavour. Thanks for yours.
Hi Guruprasad. I agree with Sally that a long acting insulin for basal once or twice a day plus fast acting insulin for before each meal works best. And for the meals it works best if you dose your insulin based on an Insulin:Carb ratio. Also, frequent testing is really required to keep blood sugar stable. It can show you what foods work or don’t work (and in what amounts). It also allows you to correct for highs more quickly so you don’t stay high for long. It’s great that you will be able to afford more test strips now. The idea of needing to eat 5-6 times a day is based on the older insulins. Once you are on an updated basal/bolus insulin regimen you should be able to eat on whatever schedule you prefer.
I strongly recommend the book Using Insulin by John Walsh. When I was first diagnosed I lived in Guatemala where I didn’t have as up to date care as I do now in the U.S. I found that reading that book and doing exactly what you are doing now, asking questions on TuD, helped me to learn how to manage my own Type 1.
My doctor suggested that some time in the future I could start Lantus as it gives better basal action and keeps hypo to a bare minimum. The question though is the availability and affordability, which I will check and will talk to my doctor during my next visit. So till then I need to do things in the traditional way.
I am starting to test more and more and I will do that as much as I can to understand foods, insulin and more importantly my body better. :)
And for the book, I will check it out. Anything that helps in understanding our body metabolism and insulin would be great. :-) Asking questions has always helped me learn in all the aspects of my life and am sure that doing the same here will undoubtedly help me and help other people who will know about things from these questions and answers. It also helps to socialize and know a lot of wonderful people,
Testing frequently and adjusting your insulin accordingly is the key. We in India dont have insurance benefits which others have in West so what I suggest is that you test consistently for 1 week at different times, this will give you a basic understanding of how your sugars are at diffrent times. In addition to that I suggest you shift to atleast 3 injections a day. I personally take Novomix 30 before breakfast and dinner and Novorapid before lunch, my sugars have been much better since last A1C was 5.8%. Also get regular excercise like walking, jogging or anything which interest you.
Hi Vikki,
Thanks for your valuable input. I take insulin twice a day though not strictly. My doctor has advised me to take a 3rd dose of rapid-acting insulin on a need basis. I have started going to gym and am still figuring out how to keep off extremes in my blood sugar levels. I will discuss with my doctor regarding these and adjust my routine accordingly.
Guruprasad, insulin is much more critical than some other medications. When you say you take insulin twice a day “but not strictly”, that is cause for concern. Skipping a dose can lead to severe high blood sugars or diabetic ketoacidosis (DKA, which can lead to a coma - very serious!). With your regimen, it could also take a day or more to get your blood sugars back on track after a missed dose. I would strongly advise against skipping doses, as you will definitely feel it in the next several hours.
Sally, is it now just marketed as “Humulin”, or is it still “Humulin N”? Because I remember there was also “Humulin R” (Regular). It’s very important not to confuse the two!
Hi Scott, what I meant to say was that I take 2 doses of insulin everyday, but the 3rd dose is optional depending on a lot of factors. My doctor is okay with it. I haven’t skipped a single dose since I was diagnosed and started insulin. Thanks for your concern
Hi Sally, when I started insulin at the time of diagnosis, I was prescribed pre-mixed Novolets, but a couple of years later my doctor felt that using separate rapid-acting and basal insulin will help and I switched. I have been using Actrapid Flexpen and Insulatard Flexpen (could be obsolete in the rest of the world) so that I could adjust each component accordingly, though I have to admit, I am still learning and I am kinda scared to experiment. The flexibility I get though is good
I have to learn carb counting for Indian food items that I get to eat daily. Normally when I count carbs and eat, the experimentation with insulin has to happen so that the dosage, timing are correct. Whenver I tried that the resulting highs and lows have always ended up scaring me. Let me try again to see if I can improve
Rice and wheat are the staple food items in India. Most of the food items are made using them - dosa, idli, chappati, poori, pulav, fried rice for example. Then for side dishes consist mainly of preparations using pulses - sambar, rasam and etc and are rich in protein but also in carbs. Typical meal consists of myriad combinations of these and counting carbs and calories is a tough task. But I will read about these and try to calculate carbs.
Typically for breakfast I have one of the tiffin items - dosa, poori, idli, pongal or etc. For lunch I have food involving rice/chappati and side dishes. Evening I have fruits/dosa/juice without sugar and night it is either tiffin items again or rice. Ugh! It is complicated, but I realize that once I find out the calories, then it is going to be an easy ride.
On a typical day, I take about 12 units of rapid-acting insulin (Actrapid Flexpen) +14 units of long-acting insulin (Insulatard Flexpen after breakfast. Then I take 10-12 units each of Actrapid and Insulatard at night. I take Actrapid after lunch only if the bg level is high.
9.9 without any basal insulin seems like a really brilliant result to me but it also seems very challenging? If you are having the problems with headaches and going up and down, basal insulin (Lantus/ Levemir or Humalin N/ Novolin N) would likely help you feel much better and have smoother control.
Insulatard Flexpen is the long-acting basal insulin that I have been using. So it is not like I haven’t using basal at all. I will discuss with my doc who suggested Lantus some time back and start. Thanks for your valuable input
d’oh, learn something every day!! I shouldn’t post anything at 5:00 AM until the coffee is ready! The insulatard looks like it’s like NPH? If that’s the case, and I don’t want to assume anything else, it could be part of the challenge. When I got my pump, the doctor and or SalesNurse explained that N (which I was using at the time, in 2008…) has only a 53% chance of peaking, and it seems most sources agree it peaks, when it’s supposed to? This means that your AM shot, intended to peak during lunch, could peak at 10:30 if you are in a hurry or 3:00 PM if it isn’t. In retrospect, a lot of the wilder swings I experienced over the years may have been due to this, along with my wild use of R to fix things that the irregularity got out of alignment.
I just looked up Actrapad I wasn’t familiar with it. It does sound from what AR says like the Insulatard is like NPH. The Actrapad sounds like what they used to call an intermediate acting insulin. It didn’t mention anything about food, but just said if you miss a dose don’t take it if it’s next to the next one.
Its onset of action is 30 min to 60 min and it lasts up to 8 hours. The fast acting insulins take effect in 15 minutes and last about 4. So I can only imagine how hard it would be to control your blood sugar with something that took so long to take effect and lasted all day! And my search engine did come on a page that says actrapad and insulatard are an outdated regimen. You said your doctor was willing to talk about Lantus (and I assume you can buy it there?). The fast acting insulins would be Humolog, Novalog or Apidra. Like AR is saying, you will find they countrol your blood sugars a lot more evenly. Your doctor may call it a basal/bolus regimen but for that you need a relatively stable long acting insulin and a very fast acting insulin
It’s hard to know the carbs of things if you don’t cook them yourself and measure everything out. I know there are some other people on here living in India. You might run a search and contact them, or join or create an India group. They could probably best share with you carb counts. Or make a specific thread asking for that in the diet and food section. Unfortunately, though you can’t completely change your food you might have to make some modifications. I’m a vegetarian and here in the U.S. it’s typical for vegetarians to eat a lot of pasta. That had to go for me. Rice is also one of those foods that many of us have problems with.
Did someone say type 1 was easy? Sigh. It’s not, so I commend you on your efforts to improve your control and hope we all aren’t overhwhelming you with our suggestions
My efforts? I have been trying harder and smarter for the past few months. So lets see what my next A1C reading says. And no, all the inputs that I am getting here on this discussion are very valuable and I am getting to learn a lot from it and by googling some of the ‘buzz words’ that were mentioned here. I agree, T1 is not easy, but it is not impossible. Even if I fail, I’d like to be able to say I tried my best and smile proudly. Having the inputs from fellow sweet people always helps.
And for the insulins, the names are Actrapid and Insulatard. Actrapid is the rapid-acting bolus equivalent and Insulatard is the NPH intermediate acting insulin. You might have got the spelling of Actrapid wrong while looking up. Here is the information from Novo Nordisk website on Actrapid - http://www.novonordisk.co.in/documents/article_page/document/pharma_insulin.asp. I agree that Actrapid and Insulatard are outdated insulins that will probably be discontinued soon, but for now they are the ones that my doctor has prescribed and are cost-effective. Now that I am employed, I don’t mind spending a bit more for better control. Lets see what my doctor recommends
Thanks, Guruprasad, you’re on here almost as often as I am! Your post came back before I edited mine. I was able to find some info on Actrapid which I added in above. It does sound like the newer rapid acting bolus insulins will give you better control, and I hope they don’t cost a lot more. I bought Lantus and Apidra off the counter when I lived in Guatemala and though they were cheaper than they’d be in the U.S. the cost added up. Does you job have any kind of insurance?
